Uncle Zhang, who was in his sixties taking care of his pet parrots, had the idea that he was suffering from "psittacosis fever" chlamydia pneumonia and sent himself to the intensive care unit and enabled artificial lung ECMO...... Looking back on the experience of the past 2 months, Uncle Zhang and his family are still in shock. Fortunately, after the multidisciplinary treatment and meticulous care of the Liangjiang New Area People's Hospital with severe care as the core, Uncle Zhang has been out of danger and transferred out of the intensive care unit.
Uncle Zhang is about to be discharged from the hospital.
Respiratory distress and multiple organ damage, ECMO escort before "ghost gate".
In the early morning of June 1, Uncle Zhang, who was transferred from the outer hospital to the Liangjiang New Area People's Hospital, had developed shortness of breath of up to 50 times per minute; Severe hypoxemia, oxygenation index (ARDS) is only about 50 mmHg, and very severe respiratory distress syndrome (normal value is greater than 300, severe value is less than 100); According to the CT results of admission, the patient's right lung is almost white-lunged. Considering that the patient's condition is very critical, the intensive care team has successively treated the patient with non-invasive ventilators, tracheal intubation, invasive ventilator-assisted breathing, prone ventilation and other treatments, and actively searched for the source of infection. After passing a series of standardized rescue procedures in the hospital, although Uncle Zhang's oxygenation index rose slightly to 120, what worried everyone was that the heart, liver, kidney, coagulation and other functions caused by the patient's hypoxia were impaired, so that the slightly improved oxygenation index dropped to below 100 again. After carefully evaluating the patient's clinical indicators, Chen Xi, director of the Department of Critical Care Medicine, and his team decided to immediately go to ECMO to support the patient's respiratory system and reduce the need for high-supportive respiratory conditions due to severe ARDS, resulting in ventilator-associated lung injury to the patient. This decision was also supported by the patient's family.
Uncle Zhang continued prone ventilation during ECMO treatment.
"Solving the case" while rescuing turned out to be the fault of the parrot
In order to make the follow-up treatment more accurate and effective, Chen Xi and her team insisted on "solving the case" while treating and seeking evidence, hoping to find the root cause of this dangerous condition as soon as possible. Although the patient himself has been in a coma since he was admitted to the hospital and cannot report his condition, Chen Xi and his team made a judgment from three aspects based on years of experience in critical first aid: first, the clinical manifestations of the patient's dyspnea; The results of the examination showed that the patient had a significant decrease in eosinophils; Imaging of the lungs shows a large white lung in the patient's right lung. Therefore, the patient is considered to have "community-acquired atypical pathogen infection". The team has been actively communicating with the family and asking if the family has a history of poultry and bird feeding, and the family members have all denied it. At the same time, Chen Xi said that the patient's symptoms were very similar to the severe pneumonia caused by chlamydia in "psittacosis" that he treated two years ago, so he specifically asked if he had been exposed to parrots. This reminded the family of the pet parrot that had been fed for 2 days before January!
It turned out that at the end of April, my daughter bought two pet parrots from the Internet, but due to a temporary business trip, I entrusted Uncle Zhang to the rookie post station in the community to help her retrieve and feed them for 2 days and then handed them over to her daughter, and the two parrots died after feeding for a week. I thought it was a small episode in life, but at the end of May, Uncle Zhang began to experience fatigue and other discomforts. Uncle Zhang's wife recalled: When I came home from the supermarket, it was very difficult to pick up the vegetables I bought. It wasn't until May 31 that he developed uncontrollable symptoms of high fever and was transferred to the hospital.
Uncle Zhang's condition was at its most severe, and he needed various life support equipment to maintain his life.
The test results coincided with the empirical judgment, and the treatment was further narrowed
Uncle Zhang was lucky, from being admitted to the hospital in the early morning of June 1 to going to ECMO on June 4, every step of the rescue process was standardized and timely. On the morning of June 1, the patient's sputum and blood were sent for metagene sequencing as soon as possible, and moxifloxacin was given according to the community-acquired atypical pathogen infection on the afternoon of June 1, and after the history of breeding "parrots" was confirmed on the afternoon of June 1, the antibiotics were adjusted to a more targeted doxycycline for the sake of insurance, and the results were obtained on June 2: the patient was infected with Chlamydia psittaci. Although symptomatic treatment has been made, due to multisystem damage caused by hypoxia, the oxygenation index drops again below 100, and ECMO is decisively applied. Chen Xi said: "When the test results are completely consistent with our judgment, my team and I are very confident in the treatment of this patient." First of all, because the team has many successful experiences with ECMO to treat patients; The second is to have rich experience in the treatment of the development of Chlamydia psittaci. ”
As judged by Chen Xi, through the treatment of ECMO, Uncle Zhang's clinical indicators have shown a state of recovery, the function of multiple organs has improved significantly, the oxygenation index has risen to 300, reaching the weaning index, and EOCM has been weaned on June 10.
After nearly a month of rescue, treatment and meticulous care, Uncle Zhang's indicators are now close to normal, and he will be discharged from the hospital smoothly.
The medical team of the Department of Critical Care Medicine placed the ECMO pipeline for Uncle Zhang.
Liangjiang people's medical science popularization
What does the Critical Care Department tell you about psittacosis?
Psittacosis, also known as ornithosis, is a naturally occurring infectious disease caused by Chlamydia psittaci that can infect birds, humans, and some mammals. The disease is common among bird hobbyists and bird workers, and is generally susceptible to the population, especially those who have close contact with birds. The incubation period for psittacosis is usually 5-21 days, with a minimum of 3 days and a maximum of 45 days.
Keep these three points in mind and stay away from psittacosis:
1. Reduce contact. Minimize direct contact with birds or birds, and avoid going to high-risk areas such as bird markets and farms; In particular, pregnant women, children and people with weakened immunity should avoid contact with birds or birds, and pay special attention not to eat birds and birds that have died of unknown causes.
2. Do a good job of personal protection. If you want to raise birds, you must buy birds with regular channels and healthy quarantine, and do not buy pets of unknown origin or suspected diseases; Bird pet keepers should pay attention to keeping the cage dry and clean, and disinfect it regularly; When touching the raised poultry, it is necessary to pay attention to hygiene, and when handling excrement, personal protection should be done, masks and gloves should be worn, and hands should be washed in time after handling. If you are scratched, you need to disinfect and clean the wound in time, and seek medical advice if necessary. In response to Uncle Zhang's situation, Chen Xi, director of the Department of Intensive Care Medicine of Liangjiang New Area People's Hospital, said that if the parrot itself carries the virus, after being delivered and other closed conditions, it is easy to form aerosols at the moment of opening, causing direct virus infection.
3. Seek medical attention in a timely manner. If your pet has suspicious symptoms, seek help from a professional veterinarian in time; If you have corresponding clinical symptoms and have a history of exposure to birds and birds, you should go to the hospital in time and inform the doctor of the relevant epidemiological history to avoid delaying treatment. (Text/Wu Ruixue)